A preliminary analysis from the federal government concluded that the sharing of staff members among multiple nursing homes — along with employees continuing to work while sick — helped to hasten the spread of the novel coronavirus in Washington state.
The Centers for Disease Control and Prevention (CDC) analyzed the timeline of a COVID-19 outbreak at a nursing facility in King County, Wash. in an attempt to determine its root causes.
“Limitations in effective infection control and prevention and staff members working in multiple facilities contributed to intra- and interfacility spread,” the CDC wrote in the most recent edition of its Morbidity and Mortality Weekly Report, released Wednesday. “COVID-19 can spread rapidly in long-term residential care facilities, and persons with chronic underlying medical conditions are at greater risk for COVID-19–associated severe disease and death.”
While the government did not name the particular facility, referring to the site throughout its report as “Facility A,” the Wall Street Journal — which initially wrote about the existence of the CDC report — identified the nursing home as Life Care Center of Kirkland “through context.”
Kirkland, Wash., a suburb of Seattle, is located in King County, and the Life Care Centers of America-operated property has been widely reported as an early epicenter of COVID-19 in the United States.
The CDC tracked the spread at the facility from the initial identification of symptoms in a resident on February 19. The 73-year-old woman had a host of medical conditions — including diabetes, chronic kidney disease, congestive heart failure, and hypertension — and was eventually transferred to a hospital on February 24 after experiencing cough, fever, and shortness of breath, according to the report.
She had not recently traveled nor made any contact with a confirmed COVID-19 patient, the CDC noted.
The facility initially reported their suspicions of coronavirus infection on February 27, the researchers determined. The patient tested positive for COVID-19 on February 28, and died on March 2, the CDC reported.
Just one week later, by March 9, the facility was linked to 129 positive COVID-19 cases, including 81 of the 130 residents, 34 staffers, and 14 visitors, according to the report; the death toll of 23 that date represented 27.2% of residents and 7.1% of visitors, though there were no deaths of staffers.
“Health care personnel with confirmed COVID-19 included the following occupations: physical therapist, occupational therapist assistant, environmental care worker, nurse, certified nursing assistant, health information officer, physician, and case manager,” the CDC reported.
By March 9, eight other skilled nursing and assisted living properties in King County had reported one or more confirmed coronavirus cases.
The investigation, conducted by a wide swath of Seattle-area public health officials, identified five major causes of the outbreak at the facility:
- Staff members who worked while symptomatic
- Staff members who worked in more than one facility
- Inadequate familiarity and adherence to standard, droplet, and contact precautions and eye protection recommendations
- Challenges to implementing infection control practices including inadequate supplies of PPE [personal protective equipment] and other items (e.g., alcohol-based hand sanitizer)
- Delayed recognition of cases because of low index of suspicion, limited testing availability, and difficulty identifying persons with COVID-19 based on signs and symptoms alone
The preliminary CDC report underscored the grave importance of infection control practices in the nation’s nursing homes, and many of the steps that authorities in Washington took in the wake of the outbreak — from restricting visitors to constant symptom monitoring of employees and residents — have been adopted nationwide.
“The findings in this report suggest that once COVID-19 has been introduced into a long-term care facility, it has the potential to result in high attack rates among residents, staff members, and visitors,” the CDC concluded. “In the context of rapidly escalating COVID-19 outbreaks in much of the United States, it is critical that long-term care facilities implement active measures to prevent introduction of COVID-19.”